The emergence of genetics-based medicines is pushing the cost of treating certain diseases to new levels, forcing hospitals and health insurers to reckon with how to cover total costs per patient approaching a million dollars.

But the price of the drugs is just the beginning, hospitals and insurers say. Administering these therapies can add hundreds of thousands of dollars to the tab, including lengthy hospital stays and use of other services and medicines.

It isn’t clear how much hospitals will get paid for these new treatments. Current payment systems generally cover infusions of drugs, or episodes of hospital care, but aren’t set up to deal with treatments that combine both. What is clear is that the total cost will be far more than the list price of the drugs themselves.

“It is about systems that don’t work well and aren’t set up for cutting-edge new technologies” says Gary Goldstein, a business manager at Stanford University’s health system, which is offering the new treatments. “And if we don’t get this one right, what about the next one?”

Million-Dollar Treatment

A new wave of gene-based therapies for cancer and other diseases threatens to bring the cost of treatment to a million dollars, because both the drug and related care are expensive.

Estimates

CAR-T Cell Therapy

Upper

end

Lower

end

1. Pre-treatment testing

CT scans, blood work and other testing to see if a patient is eligible for treatment.

$3,000

$500

2. Apheresis

The patient's cells are taken so they can be sent to the drug company, which weaponizes the cells.

3,000

6,000

3. Conditioning

Chemotherapy is given to start attacking the cancer and deplete the patient's immune system, so the CAR-T can flourish.

15,000

7,500

4. Treatment

At the hospital, specially trained staff prepare the weaponized cells for infusion in the patient. The patient is then given the therapy, kind of like getting an IV.

375,000

479,000

5. Post-treatment monitoring

Hospitals observe the patients for about two weeks for serious side effects, such as high fever and delirium, and treat them as needed.

50,000

400,000

6. Post-discharge monitoring

The patient must be seen regularly for months after treatment to ensure the disease has responded and the patient is healthy.